Effective yet underused

Movement Disorders Unit, Regional Neurosciences Centre, King's College Hospital and Institute of Psychiatry and University Hospital of Lewisham, London SE5 9RS

Over 40 years have passed since Schwab and colleagues reported the beneficial effect of apomorphine hydrochloride in Parkinson's disease.1 In 1979 Corsini et al reported the successful use of subcutaneous apomorphine in combination with domperidone,2 and this was confirmed by a series of experiments by Hardie et al.3 More recently, in 1988, Stibe et al described the successful use of continuous subcutaneous infusion of apomorphine in overcoming refractory on-off oscillations in Parkinson's disease.4 Since then at least 16 papers, mostly using open label designs (except two double blind placebo controlled studies), have been published confirming the efficacy of apomorphine given as subcutaneous “rescue” injection or continuous infusion using an automated syringe driver in Parkinson's disease.6 Apomorphine received regulatory approval in Britain in 1993, but, despite its efficacy, it remains largely underused.